Provider Demographics
NPI:1710364203
Name:WYNSMA, EMILY (MA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WYNSMA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-0568
Mailing Address - Country:US
Mailing Address - Phone:503-352-8657
Mailing Address - Fax:503-352-8658
Practice Address - Street 1:2251 E HANCOCK ST
Practice Address - Street 2:103
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2145
Practice Address - Country:US
Practice Address - Phone:971-281-3000
Practice Address - Fax:503-357-4371
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health